- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.63 / $3,116.00 / $11,581.00
| Facility | | $648.63 | $3,116.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $6,746.00 / $30,285.00
| Facility | | $2,777.00 | $6,746.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.75 / $415.51 / $551.85
| Facility | | $323.75 | $415.51 | $551.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.69 / $623.69 / $623.69
| Facility | | $623.69 | $623.69 | $623.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |